University of British Columbia documentary shows hidden human rights crisis of medical pain

For much of the Western world, physical pain ends with a simple pill. Yet more than half the world’s countries have little to no access to morphine, the gold standard for treating medical pain.

Freedom from Pain shines a light on this under-reported story. “For a victim of police torture, they will usually sign a confession and the torture stops,” says Diederik Lohman of Human Rights Watch in the film. “For someone who has cancer pain, that torturous experience continues for weeks, and sometimes months on end.”

Unlike so many global health problems, pain treatment is not about money or a lack of drugs, since morphine costs pennies per dose and is easily made. The treatment of pain is complicated by many factors, including drug laws, bureaucratic rigidity and commercial disincentives.

In India, the first stop in the film and the world’s largest grower of medicinal poppy for developed countries, there are severe restrictions to the use of morphine domestically. In 27 out of 28 states in India, narcotics laws are so strict that doctors fear prescribing it, and patients literally scream for relief. Drug companies have little incentive to manufacture morphine for the domestic market because of reporting requirements and small profit margins.

In the Ukraine, the film reveals that access to pain medication is halted by outdated, Soviet-style bureaucracy, arbitrary limits on doses, and a lack of oral morphine. As a result, many patients experience prolonged bouts of untreated pain, particularly in rural areas. In the Ukraine, we learn that Artur, a former decorated KGB colonel suffering from prostate cancer, sleeps with a gun under his pillow – his only way out, should he decide his pain is too great.

Nadia, a single mother living in Kiev, tells of the anguish of living with a son in constant pain. Vlad, her son, was diagnosed with terminal cancer and sent home from the hospital with nothing but the meagre government dose of pain killers. Nadia recounts how his agony grew to the point where he once attempted suicide, nearly throwing himself from a fourth story window. It would be another three long years of mother and son battling with severe pain until Vlad died.

Until the Ukrainian leadership acts to remove the barriers to palliative care, it falls to defiant individuals like Sergey Psiurnyk, a modern-day Robin Hood, to ensure that suffering people get the morphine they need.
Riding with Psiurnyk as he makes his rounds, he says he risks years in jail to collect morphine from sick people who do not need it and deliver it to people who do.

Overall, Freedom from Pain reveals that bureaucratic hurdles, and the chilling effect of the global war on drugs, are the main impediments to a pain free world. Patients will continue to suffer until global bodies actively work with countries to exclude medical morphine from the war on drugs, and change the blunt drug laws that curtail access to legitimate medical opiates worldwide. Uri Fedotov, the executive director of the United Nations Office of Drugs and Crime, admits in the film that the war on drugs is cutting people off from pain medication, but offers little in the way of concrete proposals for changing the status quo.

Lohman points out that inertia may be the greatest obstacle to improving access to morphine, and that pressure brought by doctors and human rights activists is critical to getting pain medication to the people who need it. That is what happened in Uganda, the final stop in the film. Dr Jack Jagwe, who served in that war-torn country’s health ministry in the 1990s, worked closely with foreign doctors and the international community to put into writing that every citizen there should have the right to palliative care – a first in Africa.

Uganda also changed its laws to allow nurses in rural areas to prescribe morphine – another first. Today, they visit people in pain and administer liquid morphine without any doctor’s involvement. Uganda is seen as a potential model for pain treatment, but most improvements around the world have been small and localised, resulting from the efforts of “enterprising entrepreneurs” like Dr M. R. Rajagopal, a pioneer of palliative care. In India, medical morphine is readily accessible only in the small state of Kerala because of his unceasing efforts.

With the help of his colleagues and the cooperation of the state drug controller, Rajagopal led the push to create a streamlined operating procedure for morphine licensing in Kerala. Now patients in desperate need of pain drugs have access and doctors do not fear strict penalties. Rajagopal, who has helped create a model for the rest of India, says what is desperately needed is “systematic evaluation of the problem … in the developing world, and an action plan aimed at overcoming it”.

This is an excellent film which describes the key issues that create the barriers to pain medication access by many people. Thank you Dr M. R. Rajagopal for helping to bring a greater awareness to this problem at a global level.

Finally Dr Rajagopal had managed to bring this issue internationally. Hopefully there will be a positive echo from International government health offices round the world.
Here the situation in my country is similar. Morphine has been turned to become an expensive medical commodity that only the have’s can afford.
The screaming pain of my pauper patients are still haunting me even they had long time gone.
My tears rolled downed each time I saw the documentary video.
Authorities shall think the other side of the coin.
They have to consider the positive benefit of morphine for relieving pain instead of just the negative side for the addicts. But as long as there is severe pain one will not get addicted.

I shall remember you with fondness Dr Rajagopal , thank you for willing to spare the time to witness the pain of the late Mrs Rita.
Thanks also for the short lecture at the hospital bringing up this issue to us all.

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